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Author Notes:

LSC conceived the idea, obtained regulatory approval, designed the study, wrote the protocol, led the conduct of the study, helped write the manuscript, produced tables and figures, and gave final approval of the version to be published.

LWB assisted with regulatory approval, made substantial contributions to the acquisition of data and data interpretation, and was involved in drafting the manuscript and revising it critically for important intellectual content.

EBM helped conduct the study, made substantial contributions to the acquisition of data and data interpretation, and was involved in drafting the manuscript and revising it critically for important intellectual content.

DD helped conduct the study, and was involved in drafting the manuscript and revising it critically for important intellectual content.

JH performed safety monitoring, and was involved in drafting the manuscript and revising it critically for important intellectual content.

ZA helped conduct the study, and was involved in drafting the manuscript and revising it critically for important intellectual content. MGS helped conduct the study, and was involved in drafting the manuscript and revising it critically for important intellectual content.

All authors have read and approved the final manuscript.

The authors would like to thank all the nurses in the George Washington University Hospital ICU for their role in conducting this study.

The authors would also like to thank Allen Solomon, MD for his assistance in shepherding this study.

George Washington University has filed for a method of use patent for the treatment of hypotension with angiotensin II based on these data. Otherwise, the authors have no conflict of interest to report.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Critical Care Medicine
  • General & Internal Medicine
  • REFRACTORY SEPTIC SHOCK
  • ENALAPRIL OVERDOSE
  • HEART-RATE
  • INFUSION
  • NOREPINEPHRINE
  • NORADRENALINE
  • SEPSIS

Intravenous angiotensin II for the treatment of high-output shock (ATHOS trial): a pilot study

Tools:

Journal Title:

Critical Care Nursing Quarterly

Volume:

Volume 18, Number 5

Publisher:

, Pages 534-534

Type of Work:

Article | Final Publisher PDF

Abstract:

Introduction: Patients with distributive shock who require high dose vasopressors have a high mortality. Angiotensin II (ATII) may prove useful in patients who remain hypotensive despite catecholamine and vasopressin therapy. The appropriate dose of parenteral angiotensin II for shock is unknown. Methods: In total, 20 patients with distributive shock and a cardiovascular Sequential Organ Failure Assessment score of 4 were randomized to either ATII infusion (N =10) or placebo (N =10) plus standard of care. ATII was started at a dose of 20 ng/kg/min, and titrated for a goal of maintaining a mean arterial pressure (MAP) of 65 mmHg. The infusion (either ATII or placebo) was continued for 6 hours then titrated off. The primary endpoint was the effect of ATII on the standing dose of norepinephrine required to maintain a MAP of 65 mmHg. Results: ATII resulted in marked reduction in norepinephrine dosing in all patients. The mean hour 1 norepinephrine dose for the placebo cohort was 27.6 ± 29.3 mcg/min versus 7.4 ± 12.4 mcg/min for the ATII cohort (P =0.06). The most common adverse event attributable to ATII was hypertension, which occurred in 20% of patients receiving ATII. 30-day mortality for the ATII cohort and the placebo cohort was similar (50% versus 60%, P =1.00). Conclusion: Angiotensin II is an effective rescue vasopressor agent in patients with distributive shock requiring multiple vasopressors. The initial dose range of ATII that appears to be appropriate for patients with distributive shock is 2 to 10 ng/kg/min. Trial registration: Clinicaltrials.gov NCT01393782. Registered 12 July 2011.

Copyright information:

© Chawla et al.; licensee BioMed Central Ltd. 2014

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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